Provider First Line Business Practice Location Address:
1550 E COVELL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95616-1352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-753-4004
Provider Business Practice Location Address Fax Number:
530-753-9734
Provider Enumeration Date:
10/24/2022